BESST + Standard Care for Suicide Prevention

Overseen By Korie Rice, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: White River Junction Veterans Affairs Medical Center

Disqualifiers: Prisoners, Institutionalized, Involuntarily committed, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 12 weeks

25 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this pilot randomized controlled trial is to test an adapted suicide prevention program (the Building VA Engagement, Self-efficacy, and Social Support To Prevent Suicide or BESST) in rural Veterans discharged from community care mental health treatment settings. The main question it aims to answer is: * Does BESST combined with standard care improve suicide-related outcomes among this population compared to standard care alone? Participants will be assigned by change to a treatment group. Some will receive the BESST intervention combined with standard care, and some will receive standard care alone. All participants will be in this research study for up to three months. Those receiving the BESST intervention will have: * 1 one-hour brief educational session; * Seven follow-up check-ins (\~30 minutes each) All participants will have three assessment interviews where they will be asked about their mental health and treatment received outside of the VA. The investigators will compare participants assigned to the BESST intervention combined with standard care vs participants assigned to standard care alone to see if the BESST intervention improves suicide-related outcomes.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue them, but you should confirm with the study team.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the study team or your healthcare provider.

What data supports the idea that BESST + Standard Care for Suicide Prevention is an effective treatment?

The available research does not provide specific data on BESST + Standard Care for Suicide Prevention. However, it does highlight the effectiveness of other treatments for suicide prevention. For example, a study on a multidisciplinary aftercare program showed significant improvements in resilience, well-being, and reduced suicidal thoughts. Another study on a group intervention for veterans found that integrating skills training and social support with safety planning could benefit those at high risk for suicide. These findings suggest that comprehensive and supportive approaches can be effective in reducing suicidal behavior. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment BESST for suicide prevention?

Research shows that programs combining social support and skills training, like BESST, can improve self-efficacy (confidence in one's ability to manage situations) and reduce suicidal thoughts. A study on a similar approach found significant improvements in resilience, well-being, and reduced distress among participants. ^{1 2 3 4 5}

What safety data exists for BESST + Standard Care for Suicide Prevention?

The provided research does not directly mention safety data for BESST or Building VA Engagement, Self-efficacy, and Social Support To Prevent Suicide. The studies focus on other interventions like SAFER and SAFE VET, which are related to suicide prevention among veterans but do not provide specific safety data for BESST. ^{3 6 7 8 9}

Is the treatment BESST a promising treatment for suicide prevention?

Yes, BESST is a promising treatment for suicide prevention because it focuses on building engagement, self-efficacy, and social support, which are important factors in reducing suicidal thoughts and behaviors. The approach aligns with successful strategies like providing support and care after a suicide attempt, which have shown to improve resilience and well-being. ^{2 7 10 11 12}

How is the BESST treatment different from other suicide prevention treatments?

BESST is unique because it focuses on building engagement, self-efficacy (confidence in one's ability to manage situations), and social support to prevent suicide, which is different from other treatments that may focus more on immediate crisis intervention or medical approaches. ^{2 7 10 11 12}

Research Team

Natalie Riblet, MD MPH

Principal Investigator

White River Junction VA Medical Center

Eligibility Criteria

This trial is for Veterans over 18, recently discharged from VA community mental health care, at risk of self-harm, and connected to specific VAMCs. They must speak English and be able to consent. Those not clinically appropriate or in vulnerable groups won't be included.

Inclusion Criteria

Be a Veteran

Be a patient connected to the White River Junction VAMC, the Togus VAMC, or the Manchester VAMC

The patient was recently discharged from a VA community care mental health treatment setting

Exclusion Criteria

I am unable to understand and give consent for treatment.

We do not plan to enroll any potentially vulnerable populations including prisoners, institutionalized patients, or involuntarily committed patients

Study physician deems the patient not clinically appropriate

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the BESST intervention combined with standard care or standard care alone

12 weeks

1 one-hour educational session, 7 follow-up check-ins (~30 minutes each)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• BESST

Trial Overview The study tests the BESST suicide prevention program alongside standard care against standard care alone for rural Veterans post-discharge. It involves an educational session, follow-up check-ins, and assessments over three months to see if BESST improves outcomes.

Participant Groups

Group I: Control Experimental Treatment 1 Intervention

Patients randomized to the control arm will receive standard mental health care alone.

Group II: BESST Experimental Treatment 2 Interventions

Patients randomized to the BESST intervention arm will receive the BESST intervention combined with standard mental health care.

Who Is Running the Clinical Trial?

White River Junction Veterans Affairs Medical Center

Lead Sponsor

Trials

32

Recruited

17,900+

VHA Office of Rural Health

Collaborator

Trials

1

Recruited

30+

Findings from Research

A study involving 39 hospice staff members showed that training in suicide prevention significantly increased their awareness of risk factors, with nearly 80% reporting improved understanding.

Participants' self-efficacy scores also significantly improved after training, indicating that such programs can effectively enhance the skills and confidence of hospice staff in addressing suicidal thoughts among patients and caregivers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suicide prevention training program for gatekeepers working in community hospice settings. Matthieu, MM., Swensen, AB.[2022]

A study involving 31 participants showed that a multidisciplinary, assertive outreach model of post-suicidal care significantly reduced suicidal ideation and distress while improving resilience and well-being at least 6 months after discharge.

Qualitative feedback highlighted the importance of staff support in recovery, suggesting that effective post-suicidal care can enhance protective psychological factors and sustain improvements in mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study. Kehoe, M., Wright, AM., Lee, SJ., et al.[2023]

Veterans have a significantly higher suicide rate than the general US population, with nearly 14% of adult suicides involving veterans, highlighting a critical public health issue.

Only 47% of veterans are enrolled in the VA Healthcare System, indicating a need for improved access to care and a proactive approach from all healthcare providers to recognize and mitigate suicide risk factors among veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers. Ruiz, F., Burgo-Black, L., Hunt, SC., et al.[2023]

In a randomized controlled trial with 148 U.S. Army Soldiers, the Collaborative Assessment and Management of Suicidality (CAMS) was found to significantly reduce suicidal ideation (SI) compared to enhanced care as usual (E-CAU) by 3 months, with a strong effect size (Cohen's d = 0.93).

Both CAMS and E-CAU led to improvements in various behavioral health outcomes, but CAMS showed a notable advantage in reducing suicidal thoughts, highlighting its potential as an effective intervention for Soldiers with significant suicidal ideation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers. Jobes, DA., Comtois, KA., Gutierrez, PM., et al.[2019]

The study will evaluate 'Project Life Force' (PLF), a novel intervention combining skills training and social support with safety planning, to see if it reduces suicidal behavior in high-risk Veterans compared to standard treatment, involving 265 participants in a randomized clinical trial.

The primary focus is on measuring the incidence of suicidal behavior during follow-up, with secondary outcomes assessing factors like depression and coping strategies, highlighting the comprehensive approach to understanding and addressing suicide risk in Veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Goodman, M., Brown, GK., Galfalvy, HC., et al.[2020]

The SAFER intervention was implemented successfully at 18 community events, reaching 1175 participants, with 61% finding it highly valuable, indicating its acceptability among those at higher risk for suicide.

Following the SAFER intervention, there was a significant increase in safe firearm storage practices (from 51.2% to 66.0%) and safe medication storage (from 14.8% to 21.6%), along with improved awareness that most firearm fatalities are due to suicide (from 33.4% to 45.8%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SAFER brief community intervention: a primary suicide prevention strategy to improve firearm and medication storage behaviour. Stuber, JP., Massey, A., Meadows, M., et al.[2022]

A brief behavioral intervention for suicidal veterans was designed and implemented in VA emergency departments, highlighting the importance of these settings in identifying and treating at-risk individuals.

Initial evaluations indicate that the intervention is feasible and acceptable, suggesting it could be effectively adapted for use in various healthcare environments, including community emergency departments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). Knox, KL., Stanley, B., Currier, GW., et al.[2022]

The SAFE VET protocol aims to test a brief intervention that combines Safety Planning Intervention with structured follow-up to effectively reduce suicide risk among Veterans in emergency departments.

This study addresses a significant gap in evidence-based interventions for Veterans at risk of suicide, focusing on enhancing their engagement in outpatient behavioral health treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rationale and study protocol for a two-part intervention: Safety planning and structured follow-up among veterans at risk for suicide and discharged from the emergency department. Currier, GW., Brown, GK., Brenner, LA., et al.[2022]

A survey of 1002 U.S. veterans revealed that while many are aware of suicide prevention programs like the Veterans Crisis Line (65% awareness), participation in community events related to these programs is very low (only 5%).

Younger veterans and those with more medical conditions are more likely to be aware of the VA's suicide prevention resources, indicating a need for targeted outreach to ensure that at-risk veterans, especially those without a history of suicidality, are informed about available support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Awareness of Suicide Prevention Programs Among U.S. Military Veterans. Tsai, J., Snitkin, M., Trevisan, L., et al.[2022]

A brief intervention and contact (BIC) program significantly reduced completed suicides among 680 suicide attempters, with an odds ratio of 35.4, indicating a strong protective effect.

The BIC program also lowered the rate of subsequent suicide attempts, with an odds ratio of 17.3, suggesting that this low-cost intervention could be an effective suicide prevention strategy in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention for suicide attempters: A randomized controlled study. Vijayakumar, L., Umamaheswari, C., Shujaath Ali, ZS., et al.[2021]

Suicide prevention has been recognized as a critical public health priority in the U.S., with a national strategy updated in 2012 and a recent Call to Action in 2021 emphasizing the need for a comprehensive approach to address various factors contributing to suicide.

Despite a slight overall reduction in suicide rates recently, significant increases were noted from 1999 to 2018, particularly affecting specific groups like adolescents, veterans, and American Indians/Alaskan Natives, highlighting the need for targeted outreach and innovative prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing the national suicide prevention strategy: Time for action to flatten the curve. Iskander, JK., Crosby, AE.[2022]

The U.S. Department of Veterans Affairs Home-Based Primary Care (HBPC) program has developed an online suicide prevention toolkit specifically for mental health providers and their teams, addressing the unique needs of Veterans with multiple health conditions.

A needs assessment involving focus groups and surveys of 109 HBPC program directors and mental health providers revealed a demand for targeted training and additional resources for managing mental health issues, highlighting the importance of integrated care teams in suicide prevention efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams. Mlinac, ME., Smith, RW., Siffert, KJ., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Suicide prevention training program for gatekeepers working in community hospice settings. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

A Practical Review of Suicide Among Veterans: Preventive and Proactive Measures for Health Care Institutions and Providers. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers. [2019]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. [2020]

6. England pubmed.ncbi.nlm.nih.gov

SAFER brief community intervention: a primary suicide prevention strategy to improve firearm and medication storage behaviour. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Rationale and study protocol for a two-part intervention: Safety planning and structured follow-up among veterans at risk for suicide and discharged from the emergency department. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Awareness of Suicide Prevention Programs Among U.S. Military Veterans. [2022]

10. India pubmed.ncbi.nlm.nih.gov

Intervention for suicide attempters: A randomized controlled study. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Implementing the national suicide prevention strategy: Time for action to flatten the curve. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams. [2023]